Re: Maternal Mortality Rate In U.S. Highest In Decades [long]
From: Meenan, Anna (annam@uic.edu)
Wed Sep 5 16:18:59 2007
I remember ritodrine from my residency years. My next-door neighbor
was receiving it in the next labor room to mine while I was in labor
with my oldest. It didn't work for her. Her kid was born the day
after mine. She also went into pulmonary edema but survived. Her
husband is a lawyer so of course sued everyone involved. Never did
hear how that came out.
Anna Meenan, MD
>.
>
>Once I practiced medicine in Tokeka, Kansas. While there, I received
>a transport
>of a patient in fulminant pulmonary edema from too much fluid, too much MgSO4,
>terbutaline, and ritodrine (does anybody out there remember ritodrine). She
>delivered shortly after I discontinued the tocolytics and the
>newborn did well.
>The motehr did not do well, however. She develped ARDS and died about a week
>later.
>
>The death certificate was signed by the pulmonologist. I noticed
>that the death
>certificate did not mention pregnancy anywhere, however. I was about to call
>the state vital statistics people, but since I was going to attend a
>meeting in
>Wichita about three weeks later, I held off.
>
>At the meeting, I found the lady in charge of Kansas vital statistics. I
>mentioned the death and that it was a maternal death. She said she
>knew. When I
>asked her how she knew, she said that she had matched the death
>certificate with
>the birth certificate and therefore was able to identify the maternal death.
>
>She went on to say that only about 1/3 of Kansas maternal deaths were noted on
>the death certificate. Anotehr 1/3 were found by matching birth and death
>certificates and the final 1/3 were found by people calling in to notify them
>of the maternal death (as I would have done had I not been planning to go to
>that meeting a few weeks later).
>
>In Kansas, only 1/3 of maternal deaths were identified on the death
>certificate.
>
>- - - -
>
>-----Original Message-----
>>From: Ina May Gaskin <midwifeim@earthlink.net>
>>Sent: Sep 5, 2007 12:31 PM
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: Re: Maternal Mortality Rate In U.S. Highest In Decades [long]
>>
>>You got that right, Luanna.
>>
>> From MMWR, CDC, September 4, 1998:
>>
>>"The number of deaths [maternal, which does not include those from
>>domestic violence] attributed to pregnancy and its complications is
>>estimated to be 1.3 to three times that reported in vital statistics
>>records."
>>
>>"Misclassification of maternal deaths occurs when the cause of death
>>on the death certificate does not reflect the relation between a
>>woman's pregnancy and her death. In addition, the inclusion of deaths
>>causally related to pregnancy that occur between 43 and 365 days
>>postpregnancy can increase the number of maternal deaths identified
>>by 5% - 10%." (Here, only the deaths within the first 42 days are
>>counted.)
>>
>> From the Green journal, October 2005:
>>
>>Underestimation of mortality causally related to pregnancy based on
>>ICD cause-of-death codes alone varied from 22% in France to 93% in
>>Massachusetts."
>>
>>Massachusetts, incidentally, is one of the states that makes the most
>>strenuous efforts to improve their reporting. What might the
>>percentage of estimated misclassification be in states that don't try
>>so hard?
>>
>>It's an honor system. No audit is possible. The practical meaning of
>>this is that we are reduced to making guesses, because we lack most
>>of the data that we should have. I'd like to see us value women's
>>lives more highly than this situation indicates.
>>
>>Most states don't have mortality-morbidity review committees; in
>>fact, we don't have as many functioning as we did in the 1970s (when
>>the maternal mortality rate was still on the decline. That decline
>>stopped in 1982, says the CDC.
>>
>> From the CDC's book "Strategies to Reduce Pregnancy-Related Deaths",
>>they write: "There are also specific rules governing coding of causes
>>of death that may leave the coder unable to assign a code that
>>indicates a relationship to pregnancy. Unfortunately, physicians are
> >rarely trained in these rules or in the correct way to complete vital
>>records."
>>
>>For direction in how to do this correctly, go to http://www.cdc.gov/
>>nchs/about/major/dvs/handbk.htm
>>
>> From CDC, Feb. 2007: "In 2003, only four states could capture
>>information consistent with the standard." What?????
>>
>>Anybody want to help me on this quilt I'm making to build awareness
>>of this problem? I know that many of you must be good at sewing. I
>>already have 16 names for 2007, more than any other year so far (and
>>I only get those which appear in the news). The death I heard about
>>this morning was a mother of 5 who kept telling her doctor that
>>something didn't feel right after her c-section. At autopsy, it was
>>found that she died from gangrene, caused by incomplete removal of
>>her placenta.
>>
>>For a sample of stories, anyone who is interested can google these
>>names: Tameka McFarquhar, Caroline Wiren, Melissa Farah, Valerie
>>Scythes, Galit Schiller, Becky Zalewski, Jasmine Gant, Karen Marie
>>Hubbard, Gwyneth Vives, Tatia Oden French, Sabine Elias, Allison
>>Lanzet, Jennifer Adams + Tripler Army Base, Julie LeMoult, Inamarie
>>Stith-Rouse. Most of these deaths don't fit the stereotype that we've
>>been discussing so far here.
>>
>>Ina May
>>
>>On Sep 5, 2007, at 5:50 AM, westsidebirthservice@juno.com wrote:
>>
>>> Ina May--where are you on this discussion? Love to hear your stats
>>> given that your understanding is that the maternal mortality rate
>>> is largely underreported--did I get that right?
>>>
>>> Louana
>>
|
|
